Provider Demographics
NPI:1437255544
Name:MITCHELL, KRISTEN ANN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4225
Mailing Address - Country:US
Mailing Address - Phone:607-729-6206
Mailing Address - Fax:607-729-1858
Practice Address - Street 1:53 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4225
Practice Address - Country:US
Practice Address - Phone:607-729-6206
Practice Address - Fax:607-729-1858
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059933-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6307Medicare ID - Type Unspecified